DOI: https://doi.org/10.22141/2224-0586.4.91.2018.137859

How expedient is the use of immunoglobulins for sepsis and septic shock?

L.A. Maltseva, N.F. Mosencev, D.V. Bazylenko, V.N. Lisnichaja

Abstract


Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 (Sepsis-3) does not recommend the use of intravenous immunoglobulins (Ig) for sepsis and septic shock (weak recommendation, poor quality of evidence). To confirm this, a randomized controlled trial was carried out on the use of intravenous immunoglobulins for sepsis and septic shock that led to a reduction in the number of hospital days in the intensive care unit, the hours of mechanical ventilation, and the number of leukocytes was more quickly normalized. The purpose of the review: to identify predictors of the expediency of immunoglobulin administration in sepsis and septic shock based on the analysis of literature data. In terms of the analysis of literature sources, our attention is drawn to the Japanese guidelines on the diagnosis and intensive care of sepsis, published in 2014, which provide answers to the following questions: 1) what are the indications for prescribing immunoglobulins; 2) at what stage of sepsis immunoglobulins are administered; 3) in what doses and for how long do they prescribe immunoglobulins; 4) what should we take into account when choosing immunoglobulin preparations. The review compare data on the use of immunoglobulins in sepsis depending on the daily dose, the dynamics of procalcitonin, C-reactive protein, lactic acid, interleukin-6 levels, Sepsis-related Organ Failure Assessment (SOFA) score (Hamano N. et al., 2013; Kusunoki M. et al. 2017). M.O. Soares et al. (2014) note the difficulty in assessing the effectiveness of immunoglobulins due to the heterogeneity of patients being examined in terms of the adequacy of saniti­zing the focus of the infection. Further studies are required in this direction, as well as an assessment of the treatment costs compared to its effectiveness. I. Martin-Loeches et al. (2017) believe that low concentrations of endogenous immunoglobulins (IgG < 407 mg/dL, IgA < 219 mg/dL, IgM < 43 mg/dL) in septic patients of the intensive care units with SOFA ≤ 8 points are associated with increased lethality and are the predictor for prescribing intravenous immunoglobulins. This therapy can improve the results of treatment when the manifestations of organ failure are reversible and not very significant (SOFA ≤ 8 points).

Keywords


sepsis; septic shock; immunoglobulins; review

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